Secretion Of PDGF,TNF-α,HA Into Nasal Fluid Before And After Sinus Surgery And The Predictive Factor Of Healing Quality

Objective To detect the changing profiles of three factors in nasal fluid before and after endoscopic sinus surgery (ESS),including platelet derived growth factor (PDGF),tumour necrosis factor-α(TNF-α) and hyaluronic acid (HA),to investigate the impact of ESS on symptoms,to evaluate the independent impact of some baseline characteristics on PDGF,TNF-αand HA perioperation,to observe the mucosal healing after ESS,and to investigate the predictive factor of healing quality after sinus surgery. Methods ①Nasal secretions were obtained from 22 patients with nasal polyp and chronic rhinosinusitis (CRS) before ESS and at 1,4,8,12 weeks after ESS compared to 22 controls.Nasal fluid was analyzed by enzyme-linked immunosorbert assay (ELISA) for PDGF ,TNF-αand HA.②Each patient completed a questionnaire that asked specific questions about his or her preoperative and postoperative symptoms.For comparing the different levels of these factors between controls and perioperation,we used the repeated measurement analysis of variance.The repeated measurement analysis of variance was also used to analyze the changes of symptoms.Multivariate regression analysis was used to evaluate the independent impact of gender,age,body mass,preoperative stage on PDGF,TNF-α,HA before and after ESS.③The healing quality was evaluated at 1,4,8,12 weeks postoperatively for every one.Every timewe recorded the chronic rhinosinusitis healing survey forms according toobservation.Based on the morphological character of mucosa in sinus cavity afterESS,wedefinedepithelizationtogoodhealing,andotherstopoorhealing.Finally,we performed a multiple logistic regression model to assesswhether the healing quality at 8,12weeks postoperatively was associated withage,gender,body mass,preoperative stage and concentrations of PDGF,TNF-α,HA before ESS.Results Y The concentrations of PDGF (pg/ml) in nasal secretions in controls,before and at 1,4,8,12 weeks after operation (mean±stand error) were397.486±25.343 ,323.166±78.075 ,3935.926±479.640 ,938.395±133.125 ,849.956±138.286,629.481±125.336,respectively.The amounts of PDGF began toincrease postoperatively,reaching the peak at postoperative 1 week,then graduallydecreased,reachingnormalconditionsat12week(comparedtocontrols,P=0.087).There was no significant difference in PDGF levels betweencontrols and preoperation.The values of TNF-α(pg/ml) in nasal fluid in controls,pre-and at 1,4,8,12 weeks post-operation (mean±stand error) were 66.240±3.368,90.576±9.890 ,166.948±34.166 ,153.801±39.745 ,139.371±41.001 ,128.364±16.338 ,respectively.The TNF-αshowed high levels at 1 week,thendecreased down to 8 week (compared to controls,P=0.092),and showed a secondpeak at 12 week (compared to controls,P=0.001).Compared to control subjects,thepatients had a significant increase (P=0.029) in TNF-αconcentrations beforesurgery.The levels of HA (ng/ml) in controls,before and at 1,4,8,12 weeks aftersurgery (mean±stand error) were 1226.340±59.352 ,877.068±80.613 ,1398.073±33.620,1129.105±70.595,1137.909±67.948,1127.460±64.341,respectively.A increase in HA concentrations in nasal fluid wasdemonstrated at 1 week.No significant differences were found between controlsand 4 week (P=0.304),or between controls and 8 week,or between controls and 12week.Compared to the control group,low HA amounts in nasal secretions before ESS were found (P=0.003).②Symptom scores pre-and at 1,4,8,12 weeks post-operatively (mean±stand error) were 9.727±0.473 ,4.273±0.512 ,2.864±0.332,2.227±0.343,1.864±0.210,respectively.During the postoperative period,the patient symptoms showed an impressive improvement.There was a trend toward continued subjective improvement with longer follow-up,but the changes did not reach statistical significance between 8 and 12 week (P=0.161).This reflected that there was a marked changes on symptoms before 8 week,and a slight changes after that.Multivariate analysis showed that the concentrations of TNF-α,HA before surgery were both correlated with body mass (r=0.879,0.919,respectively),the levels of PDGF at 1 week was associated with age and body mass (r=0.913),the amounts of three factors at 4 week were all related to body mass (r=0.842,0.643,0.968),the values of HA at 8 week was related to body mass (r=0.960).At 12 week,we did not find any correlation.③Accoding to the three stages after FESS reported by Xu Geng,the patients at stage of the first,second,third at 1 week were 15,7,0,respectively,at 4 week were 1,20,1,at 8 week were 0,14,8,at 12 week were 0,4,18.8 patients were in good healing at 8 week,while 14 in poor healing.18 patients were in good healing at 12 week,while 4 cases in poor healig.The healing quality at 8 and 12 week were both related to patient age and preoperative PDGF concentrations in nasal secretions. The younger,the better healing.The lower PDGF concentration,the better healing,and vice versa.In contrast,gender,body mass,preoperative stage and amounts of TNF-α,HA preoperatively did not have any impact on healing outcome. Conclusion ①Comparing patients at 1 week after surgery with control subjects,a significant increase in the concentrations of PDGF,TNF-α,HA in nasal secretions could be demonstrated.After that,decreasing amounts of these factors were found,reaching normal conditions at 12 week for PDGF,8 week for TNF-α,4 week for HA.But there was another peak for TNF-αat 12 week.Each factors beforesurgery also showed different levels when compared to controls,PDGF were constant, TNF-αwere high,and HA were low. During the wound healing of nasal mucosa,the amounts of PDGF,TNF-α,HA were different at each postoperative stage.The symptoms of patients were drastically improved with before surgery.But there was a marked changes before 8 week,and a slight changes after that.The amounts of three cytokines in nasal fluid perioperation were correlated with different factors,especially associated with body mass.At the different phase of wound healing after ESS,the morphological character of mucosa in sinus cavity differs significantly.More patients were at stage of complete epithelization at 8 and 12 weeks. The healing quality after ESS was significantly and independently correlated to patient age and preoperative PDGF levels in nasal secretions. The younger,the better healing.The lower PDGF concentration,the better healing,and vice versa.Age and PDGF concentrations preoperatively were suitable factors to predict the healing quality after ESS.